Credentialing Coordinator / Credentialing Specialist (On-site)

The Villages, FL

Full Time

6503 Powell Road, The Villages, FL

Experienced

Please note this is not a remote position.

About The Villages Health
The Villages Health is a patient-centered primary care driven, multi-specialty medical group with over 800 team members. Our unique care model gives us both the time and resources to truly care for our patients, along with a company culture that supports a healthy work-life balance for our team members. Our purpose, mission and vision is to empower Villagers and the surrounding communities to live out their dreams by keeping them healthy and healing them quickly. Together, we are changing the way healthcare is delivered and are making a positive difference in the lives of our patients and the communities we serve. In doing so, The Villages Health is creating America’s Healthiest Hometown.

Our Full-time Benefits
Medical, Dental & Vision Insurance | Matching HSA & 401k | PTO & Paid Holidays | The Villages Charter School Eligibility | & much more!

Hiring Event
Please bring your resume and join us:

Friday, August 15^th from 9:30 AM to 1:30 PM at The Villages Health Administrative Office (6503 Powell Road, The Villages, FL 32163) – RSVP’s are encouraged through Eventbrite at https://bit.ly/4jOlUm2

Responsibilities:
Under general supervision, the Credentialing Coordinator’s primary responsibility is to perform the credentialing/re-credentialing of Clinicians for the Villages Health, LLC. This process includes review of credentialing packet upon receipt by Clinician, preparation/maintenance of provider files, and data entry. The Credentialing Coordinator will assist with report preparation to be reviewed by the Executive Leadership Team. The Credentialing Coordinator works closely with the Revenue Cycle Manager and Clinician Recruiter in maintaining network integrity and with the Recruitment Manager in developing procedural workflows.

Essential Duties and Responsibilities:

Organizes and oversees the credentialing and payor enrollment process with all participating health plans.
Coordinates the gathering and verification of necessary data, working directly with Clinicians or appropriate representatives.
Completes applications accurately and thoroughly, meeting standards set forth by CMS.
Obtains application signatures from the authorized signatory and provide all required supporting documentation.
Serves as a liaison with malpractice agency to insure Clinicians.
Inputs Clinician’s information and completes the electronic credentialing process through the applicable
- electronic system; maintains Clinician’s electronic data files when changes are identified.
Submits applications and follows processes to ensure progress.
Maintains the accuracy of Clinician’s CAQH profiles and coordinate re-attestation every 120 days.
Responds to deficiency notifications received pertaining to application processing in a timely manner. Attains, verifies, and disseminates state required billing numbers and approval letters as needed.
Serve as liaison between health plans and TVH in resolution of issues related to credentialing and plan participation.
Creates, maintains, and disseminates plan participation status and billing information through the application electronic tracking system for billing, managers, and executives to maximize collections in the revenue cycle management process.
Stays abreast of insurance terms and regulatory changes by researching legislation and state requirements. Researches accrediting organization requirements. Services as an educational resource on the subject of credentialing and payor-specific participation requirements.
Establishes policies and procedures consistent with NCQA standards. Maintains a Managed Care Credentialing and Provider Enrollment Manual, which includes detailed instructions on payor-specific application requirements for participation with Medicare, Medicaid, and commercial health plans.
Continuously analyzes the effectiveness of the current credentialing process and create departmental workflows for reducing delays in participation.
Processes and maintains all Clinic licensures to include, but is not limited to, AHCA, HCCE, RMR BWOP, and CLIA as they are due.
Participates in other duties and responsibilities as assigned.

Education/Experience Requirements:

High School Diploma
Associates in Medical Staff Services Preferred
Certified Provider Credentialing Specialist (CPCS certification) Preferred
3-5 years of experience with credentialing for hospital, primary care and multi-specialty groups
Proficient in Microsoft Office Word and Excel
Complete understanding of major health plans including Medicare, UHC and BCBS
Ability to communicate clearly with all levels of management, and providers
Excellent organizational and time management skills
Excellent verbal and written communication skills

Salary is commensurate with experience.

Questions? Contact us at [email protected]

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I certify that I have read and understand the applicant instructions included with this application and that the answers given by me to the foregoing questions and statements made by me are complete and true to the best of my knowledge and belief.

I understand that any false information, omissions, or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment.

I understand that The Villages Health is an equal opportunity employer and does not unlawfully discriminate in employment and this application form is intended for use in evaluating my qualifications for employment and that this application is not an offer of employment.

I further understand that if hired, my employment will be considered "at-will" and that my employment may be terminated for any reason, with or without cause or notice, at any time by me or the Company and that this application is not intended to constitute a contract of continued employment.

I hereby authorize The Villages Health to contact, obtain, and verify the accuracy contained in this application. I authorize all persons, educational institutions, corporations, companies, agencies, and references to supply any information concerning my background. This includes authorizing the release of information about non-judicial punishment that might have occurred in any branch of the military service. If an official background check of my credit and criminal history is needed, a separate Disclosure Statement and Authorization will be provided to me.

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Credentialing Coordinator / Credentialing Specialist (On-site)

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